Loading...
HomeMy WebLinkAbout2025-00012162 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I01101100 lflfl I VIII ft 1111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00373 691 u, 1 u21 1 1 8 u, 2 U299 u, 1 U2 1 u,99 U2 99 3 10 u, 3 U2 1 *P0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑5501-51,500 ®ON SCENE 15 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 2025I 2025-00012162 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 S MCLEAN BLVD El In 05:16 ® ❑ RELATED ❑Y ®N 02 24 2025 ❑AM ❑YES ®NO U1 -< g PRIVATE mo !day!yr ®PM FLOW CONDITION IT1 O0 !MI N E S W MeyerSt COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 Cl) Oy Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL ❑EDUES ❑NW ❑ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C) FOR DAMAGEDAREA(S) FROPtf TOWED U1 Q NAME(LAST,FIRST,M) y mo /2 0 0 6 Scion TC 2006 00-NONE , 2 _2, DUE TO CRASH 0 13-UNDER CARRIAGE ©,I �. FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 2 f11 M 2 SYTM 4 ❑Y ❑SNE®UNK VEH. 9 ATCRASHD 9 15-OTHER 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it �i 4 COM VEH 0 Ea 1 C) I— FIRST CONTACT 11 7__�_-6_;__5 *II Yes.See Sidebar U1 0 Z ELGIN IL 60123 0 1 0 EQ22463 IL 2025 REAR M TELEPHONE IL D JTKDE177X60106677 Pronto Insurance Agency ®Y 0 N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Gutierrez Deras. Belarmina ILP3408784 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 7] m g DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 i,uv 0 NOV 0 Dv yr Kia Motors Cofpoul 2017 oo-NONE 00i,O DUETOCRASH ❑ 2 x 0 13-UNDER CARRIAGE 10. I. 2 FIRE El ® U2 C Ti F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8_i 6 1� 4 COM VEH ❑ ® U1 CO FIRST CONTACT 12 Y._:�_, =6 •If Yes.See Sidebar C ELGIN IL 60120 0 1 0 AB63440 IL 2025 I:EaR 4 CI) IL D 0 KNDJP3A54H7444111 American Family Insurance ❑Y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Same 410560682678 BAc E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = iUNIT) ISEATI (D08) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 4 08 / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 02,24 /2025 05 16 ®PM in a Work Zone? ®N DIRP co 1 F PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 3 C) T 0 2 0 2 28 , , ❑PM- ❑Construction R 3 0 $I CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 o ® 11 1 ARREST NAME Mejia Gutierrez. Frelyn.S. 6-101 1525000548 , ! El PM SLMT igi CITATIONS ISSUED 0 PENDING Utility F 2 El ARREST NAME Mejia Gutierrez. Frelyn.S. 11-601-Ax 1525000549 02 r 24 ,2025 05 18 ®PM El Unknown work zone type U1 35 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35 1525-NavE.Oscar 601 03 ,24,2025 09 00 ❑PM ®N U2 REMEMBER TO USE BLACK INK,PRESS HARD,PRINT LEGIBLY AND COMPLETE ALL REQUIRED FIELDS! A Diagram and Narrative are required on all Type B crashes, LARGE TRUCK, BUS, OR HM VEHICLE even if units have been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z i•____r____; I • WOO* combination):or ratingmore thanpounds(example:truck or truck trailer -I tin 10,000 INDICATE NORTH BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n - } (example:shuttle or charter bus):or X L A I — — — — 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O } } } transporting employees In the course of their employment(example:employee X / transporter-usually a van type vehicle or passenger car):or w ` L.___a ; Unit i •4. Is used or designated to transport between 9 and 1 passen rs,including the driver. N for direct compensation(example:large van used fors cific purpose):or O ____i____ Not To Scale I _ < < I L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires - ( placarding(example:placards will be displayed on the vehicle). XI —1 CARRIER NAME Z ADDRESS 0I T. ICITY/STATE/ZIP C _ i. i. i. 4. MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I I ❑ Not in Comm./Govt. 0 Not in Comm./Other 0 USDOT NO. ILCC NO. C XI Source of above Z . own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes II El Unknown C Was a driver/vehicle Examination Report Form completed? r HAZMAT ❑Yes 0 No ❑Unknown Out of Service ❑Yes ❑No 7 MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No C Z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Blue White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE